Autoimmune Hashimoto’s encephalopathy: a case report

O.Ye. Dubenko, O.V. Kovtunov, S.V. Yekimova, V.V. Kulgeyko, D.P. Kovalenko, T.V. Nevolina, L.I. Kovalenko


Hashimoto’s encephalopathy was described as an immune-mediated neuroendocrine disorder associated with autoimmune Hashimoto’s thyroiditis. Hashimoto’s thyroiditis is the most frequent cause of hypothyroidism; however, encephalopathy may also develop in patients with autoimmune thyroid diseases independent of actual thyroid function level. Hashimoto’s encephalopathy is a relatively rare disease with variable clinical manifestations including epilepsy, disturbance of consciousness, cognitive impairment, memory loss, hallucinations, stroke-like episodes, myoclonus, tremor, involuntary movements, language impairment, and gait disorders. Development of acute psychosis is one of common clinical manifestations. Hashimoto’s encephalopathy is characte­rize by the presence of elevated circulating antibodies, especially anti-thyroid peroxidase and anti-thyroglobulin as important serological marker. The good response to glucocorticoids in patients with Hashimoto’s encephalopathy indicates its autoimmune nature. Here we are reporting a case of Hashimoto’s encephalopathy with typical presentation of seizure, disturbance of consciousness, hallucination, tremor, that were associated with autoimmune thyroiditis and hypothyroidism, high level of anti-thyroid peroxidase and anti-thyroglobulin antibodies. The treatment with methylprednisolone, L-thyroxine and selenium showed slow improvement.


Hashimoto’s encephalopathy; autoimmune thyroiditis; anti-thyroid peroxidase antibodies; neuropsychiatric symptoms


Chong J.Y., Rowland L.P., Utiger R.D. Hashimoto encephalopathy: syndrome or myth? // Arch. Neurol. — 2003. — Vol. 60. — P. 164-171.

Bauer M., Goetz T., Glenn T., Whybrow P.C. The thyroidebrain interaction in thyroid disorders and mood disorders // J. Neuroendocrinol. — 2008. — Vol. 20. — P. 1101-1114.

Marshall G.A., Doyle J.J. Long-term treatment of Hashimoto’s encephalopathy // J. Neuropsychiatry Clin. Neurosci. — 2006. — Vol. 18. — P. 14-20.

Brain L., Jellinek E.H., Ball K. Hashimoto’s disease and encephalopathy // Lancet. — 1966. — Vol. 2. — P. 512-514.

Shaw P.J., Walls T.J., Newman P.K., Cleland P.G., Cartlidge N.E. Hashimoto’s encephalopathy: a steroid-responsive disorder associated with high anti-thyroid antibody titers-report of 5 cases // Neurology. — 1991. — Vol. 41(2 (Pt. 1)). — P. 228-233.

Ferracci F., Bertiato G., Moretto G. Hashimoto’s encephalopathy: epidemiologic data and pathogenetic considerations // J. Neurol. Sci. — 2004. — Vol. 217. — P. 165-168.

Mocellin R., Walterfang M., Velakoulis D. Hashimoto’s encephalopathy: epidemiology, pathogenesis and management // CNS Drugs. — 2007. — Vol. 21. — P. 799-811.

Tamagno G., Federspil G., Murialdo G. Clinical and diagnostic aspects of encephalopathy associated with autoimmune thyroid disease (or Hashimoto’s encephalopathy) // Intern. Emerg. Med. — 2006. — Vol. 1. — P. 15-23.

Caturegli P., De Remigis A., Rose N.R. Hashimoto thyroidi-tis: clinical and diagnostic criteria // Autoimmun. Rev. — 2014. — Vol. 13. — P. 391-397.

Pandit A.A., Vijay Warde M., Menon P.S. Correlation of number of intra-thyroid lymphocytes with antimicrosomal antibody titer in Hashimoto’s thyroiditis // Diagn. Cytopathol. — 2003. — Vol. 28. — P. 63-65.

McLachlan S.M., Rapoport B. Why measure thyroglobulin autoantibodies rather than thyroid peroxidase autoantibodies? // Thyroid. — 2004. — Vol. 14. — P. 510-520.

Oide T., Tokuda T., Yazaki M., Watarai M., Mitsuhashi S., Kaneko et al. Anti-neuronal autoantibody in Hashimoto’s encephalopathy: neuropathological, immunohistochemical, and biochemical analysis of two patients // J. Neurol. Sci. — 2004. — Vol. 217. — P. 7-12.

Fujii A., Yoneda M., Ito T., Yamamura O., Satomi S., Higa H. et al. Autoantibodies against the amino terminal of alpha-enolase are a useful diagnostic marker of Hashimoto’s encephalopathy // J. Neuroimmunol. — 2005. — Vol. 162. — P. 130-136.

Schauble B., Castillo P.R., Boeve B.F. et al. EEG findings in steroidresponsive encephalopathy associated with autoimmune thyroi-ditis // Clin. Neurophysiol. — 2003. — Vol. 114. — P. 32-37.

Tsai M.H., Lee L.H., Chen S.D., Lu C.H., Chen M.T., Chuang Y.C. Complex partial status epilepticus as a manifestation of Hashimoto’s encephalopathy // Seizure. — 2007. — Vol. 16(8). — P. 713-716. DOI: 10.1016/j.seizure.2007.05.018. PMID 17600734.

Nolte K.W., Unbehaun A., Sieker H. et al. Hashimoto ence-phalopathy: a brainstem vasculitis? // Neurol. — 2000. — Vol. 54. — P. 769-770.

Duffey P., Yee S., Reid I.N. et al. Hashimoto’s encephalopathy: postmortem findings after fatal status epilepticus // Neurol. — 2003. — Vol. 61. — P. 1124-1126.

Wilcox R.A., To T., Koukourou A., Frasca J. Hashimoto’s encephalopathy masquerading as acute psychosis // J. Clin. Neurosci. — 2008. — Vol. 15(11). — P. 1301-1304. DOI: 10.1016/j.jocn.2006.10.019. PMID 18313925.

Гусова А.Б., Кашинский А.А. Энцефалопатия Хашимото — аутоиммунное заболевание головного мозга (современные итоги изучения). — Харьков, 2013. — 232 с.

Horikoshi S., Miura I., Kunii Y. et al. Hashimoto encephalopathy with high plasma monoamine metabolite levels: a case report // Neuropsychiatr. Dis. and Treatment. — 2017. — Vol. 13. — P. 1043-1045.

Chang J.-S., Chang T.-C. Hashimoto’s encephalopathy: Report of three cases // Journal of Formosan Medical association. — 2014. — Vol. 113. — P. 862-866.

Mijajlovic M., Mirkovic M., Dackovic J., Zidverc-Trajko­vic J., Sternic N. Clinical manifestations, diagnostic criteria and therapy of Hashimoto’s encephalopathy: report of two cases // J. Neurol. Sci. — 2010. — Vol. 288(1–2). — P. 194-6.

Lancaster E. The diagnosis and Treatment of Autoimmune Encephalitis // Journal of Clinical Neurology. — 2016. — Vol. 12(1). — P. 1-13.

Kelly B.P., Patel S.C., Marin H.L. et al. Autoimmune Encephalitis: Pathophysiology and imaging Review of an Overlooked Diagnosis // AJNR. — 2017. — Vol. 38(6). — P. 1070-1078.


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